Lo Hui Zhen, Leow Kevin, Hii Rachael, Nerlekar Nitesh, Ebeling Peter R, Rodríguez Alexander J
Peninsula Health, 2 Hastings Road, Frankston, VIC, 3199, Australia.
Department of Cardiology, Canberra Hospital, Woden, Yamba Dr, Garran, Australian Capital Territory, 2605, Australia.
Osteoporos Int. 2025 May;36(5):779-799. doi: 10.1007/s00198-025-07468-3. Epub 2025 Apr 7.
Vascular calcification shares many features with skeletal mineralisation and shares an inverse relationship with osteoporosis (skeletal de-mineralisation). However, medications that reduce bone loss (anti-resorptives) have had inconsistent effects on extra-skeletal mineralisation (i.e. vascular and valvular calcification). As such, this paper aims to synthesise existing literature examining the effect of anti-resorptive treatments on extra-skeletal (vascular and valvular) calcification across populations.
Medline and Embase were searched (inception to October 2024) for studies that assessed the association between anti-resorptive medication use and vascular/valvular calcification. Pooled standardised mean differences (SMDs) with 95% confidence intervals (CI) were calculated for all outcomes, using random-effects model. Leave-one-out sensitivity analyses were performed for internal validity.
Of 4071 articles screened, 33 were included in the review, and 15 (2344 participants) had data available for meta-analysis. Anti-resorptive use was associated with non-significant, small magnitude improvements in abdominal aortic calcification (decreased value), coronary artery calcification (decreased value) and ejection fraction (increased value) but significant small reduction in aortic valve area (representing less calcification on the valve) with standardised mean difference of - 0.45 (95% confidence interval (CI) - 0.99; 0.08, I = 84%), - 1.19 (95% CI - 2.92; 0.55, I = 91%), - 0.67 (95% CI - 1.72; 0.38, I = 94%), 0.26 (95% CI - 0.14; 0.66, I = 62%) and 0.56 (95% CI 0.07; 1.06, I = 76%), respectively.
The significance of small positive effect of anti-resorptives on aortic stenosis is clinically uncertain. Despite strong biological links between vascular calcification and skeletal mineralisation, anti-resorptives do not appear to have a strong favourable influence on extra-skeletal mineralisation. This suggests that mechanisms that link vascular calcification with osteoporosis may be acting in pathways not influenced by anti-resorptives. This systematic review and meta-analysis summarises the effect of anti-resorptives on vascular and valvular calcification. There is a small, positive effect of anti-resorptives on aortic stenosis, though this is of uncertain clinical importance.
血管钙化与骨骼矿化有许多共同特征，且与骨质疏松症（骨骼脱矿）呈负相关。然而，减少骨质流失的药物（抗吸收药物）对骨骼外矿化（即血管和瓣膜钙化）的影响并不一致。因此，本文旨在综合现有文献，研究抗吸收治疗对不同人群骨骼外（血管和瓣膜）钙化的影响。
检索Medline和Embase（从创刊到2024年10月）中评估抗吸收药物使用与血管/瓣膜钙化之间关联的研究。使用随机效应模型计算所有结局的合并标准化均值差（SMD）及其95%置信区间（CI）。进行留一法敏感性分析以评估内部效度。
在筛选的4071篇文章中，33篇纳入综述，15篇（2344名参与者）有数据可用于荟萃分析。使用抗吸收药物与腹主动脉钙化（值降低）、冠状动脉钙化（值降低）和射血分数（值增加）的微小改善相关，但主动脉瓣面积有显著小幅减小（表明瓣膜钙化减少），标准化均值差分别为-0.45（95%置信区间（CI）-0.99；0.08，I=84%）、-1.19（95%CI-2.92；0.55，I=91%）、-0.67（95%CI-1.72；0.38，I=94%）、0.26（95%CI-0.14；0.66，I=62%）和0.56（95%CI 0.07；1.06，I=76%）。
抗吸收药物对主动脉瓣狭窄的微小积极作用的临床意义尚不确定。尽管血管钙化与骨骼矿化之间存在紧密的生物学联系，但抗吸收药物似乎对骨骼外矿化没有强大的有利影响。这表明将血管钙化与骨质疏松症联系起来的机制可能作用于不受抗吸收药物影响的途径。本系统综述和荟萃分析总结了抗吸收药物对血管和瓣膜钙化的影响。抗吸收药物对主动脉瓣狭窄有微小的积极作用，但其临床重要性尚不确定。
